Care Home: Westmeade

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What the care home does well The home is being well run and the needs of residents are being met. Staff spoken to said that they are aware of residents needs and that the management team is approachble and supportive. Prospective individuals, significant others and potential placing authorities are provided with relevant information about services and encouraged to visit the care home. Care plans are `person centred` and reviewed on a regular basis to address the changing needs of individuals. The care planning approach involves the resident and significant others, in order to ensure the needs, wishes and aspiration of the individual are at the centre of service delivery. Staff support people with learning disabilities in a professional manner giving them a high profile to enabling them to learn independent living skills and participate in meaningful activities and work to reflect their wishes and needs. The environment is well maintained and a good standard of cleanliness was evident throughout those areas viewed. The systems in operation including complaint and adult protection should offer adequate protection to people using the service. In relation to equality and diversity, the home has this policy in place and staff spoken to were aware of it and ensured that people were treated equally irrespective of their age, race, disability, religious beliefs, cultural background and sexual orientation. residents are supproted to access church and church social events. What has improved since the last inspection? New garden furniture and a new shed have been provided. One of the bedrooms has been redecorated with the colour and layout of the room chosen by the resident. What the care home could do better: The registered provider should ensure that: The Statement of Purpose in a format that is user friendly and easy to read. The Service User`s Guide should include the Complaints Procedure. The Complaints Procedure should include timescales for responding to complaints and should be updated to provide the correct contact details of the Care Quality Commission. An audit of the residents` money handed over for safe keeping should be carried out on a regular basis so that residents are protected and safeguarded from abuse. Other means of hand drying facilities should be provided in the bathroom so as to control the spread of infection. All staff should receive structured induction training so that they are able to fulfill the aims of the home and meet the changing needs of the residents. All staff should have regular, recorded formal supervision meetings at last six times a year. Training in hygiene and control of infection should be provided for all staff so that safe practices are maintained to control the spread of infection. Key inspection report Care homes for adults (18-65 years) Name: Address: Westmeade 69 Westmeade Close Cheshunt Hertfordshire EN7 6JP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bijayraj Ramkhelawon     Date: 1 4 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Westmeade 69 Westmeade Close Cheshunt Hertfordshire EN7 6JP 01992629963 01992629963FP westmeade69@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs P Lopez,Dr S Collen care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: This home is registered for 3 people mental disorder (only when asociated with a learning disability) Date of last inspection Brief description of the care home Westmeade is a three-bedded semi-detached house and is located in a quiet close on a modern residential estate in Cheshunt. The house is domestic in design, style and decor, with a small office on the first floor. There is a pleasant garden to the rear. It is close to the town centre with its shops, leisure facilities, railway station, bus service and other amenities. The home provides accommodation for three women with learning disabilities and associated mental health support needs. The service offered is specialised and individually tailored to meet the complex needs of the individual service users. The home is staffed twenty-four hours a day. Information regarding the service can be obtained from the Statement of Purpose and Service Users Guide. These documents, up to date fee information (fees range from Care Homes for Adults (18-65 years) Page 4 of 26 3 3 Over 65 0 0 Brief description of the care home £1385 to £1650- as at 09/09/2009) and a copy of the most recent inspection report can be obtained from the manager on request. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was carried out on the 11th october 2007. Since this inspection an Annual Service Review (ASR) was completed on the 23rd September 2008. An Annual Service Review is a summary of our knowledge of a service that has not had a key inspection in the last year. It is also how we decide if a service is still as good as we thought it was at the last key inspection or annual service review. This unannounced key inspection was carried out on the 9th October 2009 and took one day. Although the inspection was conducted by just one inspector representing the Commission, for the purposes of this report this will be stated as we. It included talking to staff, examining care plans, staff files, staff training records, fire safety procedures, medicine records, maintenance records, all other records and documents and a tour of the premises. We looked at all the information we have asked for or received about the home, since Care Homes for Adults (18-65 years) Page 6 of 26 the last inspection. This information included the Annual Quality Assurance Assessment (AQAA), sent by and returned to the Commission from the homes Acting Manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also provides some statistical information about the service. The information provided in the AQAA was also checked against the findings as set out in the last inspection report. On the day of the inspection there were three people in residence. Two people were attending the day centres and one person was in the home. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The registered provider should ensure that: The Statement of Purpose in a format that is user friendly and easy to read. The Service Users Guide should include the Complaints Procedure. The Complaints Procedure should include timescales for responding to complaints and should be updated to provide the correct contact details of the Care Quality Commission. An audit of the residents money handed over for safe keeping should be carried out on a regular basis so that residents are protected and safeguarded from abuse. Other means of hand drying facilities should be provided in the bathroom so as to control the spread of infection. All staff should receive structured induction training so that they are able to fulfill the Care Homes for Adults (18-65 years) Page 8 of 26 aims of the home and meet the changing needs of the residents. All staff should have regular, recorded formal supervision meetings at last six times a year. Training in hygiene and control of infection should be provided for all staff so that safe practices are maintained to control the spread of infection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their needs would be assessed and met. Information about the home is available so that people would be able to make an informed decision but this information should be in an easy read format. Evidence: Adequate information about the home including a copy of the Statement of Purpose and Service Users Guide was available to current and prospective residents. This ensures that people have appropriate information about the service. We saw that the Statement of Purpose was not in a format that is user friendly. The fonts were small and the texts were very close that makes this document difficult to read. The Service Users Guide did not include a complaints procedure as required by regulation. This would ensure that people using the service would be aware of how to make a complaint and that their concerns would be listened to and acted upon. Care plans examined showed that an assessment of individuals needs was carried out prior to moving in. This process involves the input of the prospective resident, their family and other professionals. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: As stated in the AQAA, the provider will within the next twelve months ensure that both the Statement of Purpose and the Service Users Guide are pictorial documents. Care Homes for Adults (18-65 years) Page 12 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their identified needs would be met and that they would be enabled to live the lifestyle they choose. Evidence: Each person has a person centred plan of care based on their views about how they wish to be supported from day to day and longer term goals. These are reviewed on a regular basis and any changes are reflected within the support plan. Each care plan includes the assessment of needs, various risk assessments, the residents profile, communication folder with symbols and photographs, information about support provided, keyworker system and a day care programme. As stated in the AQAA, the provider will continue to work with the residents on their person centred plan to achieve their identified goals. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to engage in appropriate activities, accessing local community amenities and that their rights are respected. Evidence: Each resident has a range of activities as detailed in their care plan. They are enabled to actively participate in a variety of activities within the local community. Residents attends day centres, social events and use local facilities of their choice. One resident attends a day centre in Stevenage and another in Hoddesdon. Leisure time is flexible so that residents can choose what to do and whom they want to be with. Friendships are encouraged and staff support people in making arrangements for friends and families to meet at the home or in another setting. Menus are varied and each resident is involved in choosing what to eat. Staff Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: encourage residents to prepare drinks, snacks and meals and sit with them in a family-like setting. The home provides annual holidays for the residents and has good links with people living in other homes within the same organisation. Staff also support residents in trips to the coast, swimming and regular trips to the cinema. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their individual personalities through the choices they make. They are able to access local community health services to maintain and promote a healthy lifestyle. Evidence: Care plans examined showed that residents identified needs were being met and that all residents are registered with a G.P. Individuals receive personal and healthcare support using the care plan that was reviewed and kept up to date at each health appointment attended. Staff spoken to said that the support provided for residents was based upon identified needs including the rights of dignity, privacy, choices and respect. A new system was introduced this week and medicines are now supplied in blister packs. Overall, there are good systems in place for ordering, storing and administering the medication that the each resident requires. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall ethos of the organisation that runs through staff recruitment, training, supervision and the policies and procedures in place should protect residents from harm or abuse. Evidence: The home has a detailed complaints procedure devised in a user friendly format with symbols and pictures. However, we saw that this procedure did not include timescales for responding to complaints and has not been updated with the correct contact details of the Commission. A record is maintained of any complaints made detailing actions and outcomes as necessary. There have been no complaints received since the last inspection. A detailed procedure is in place to ensure that residents are protected from abuse and harm. Staff received Safeguarding Adults training. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). We saw that an audit of residents money handed over for safe keeping has not been carried out for over 3 years so that they are protected and safeguarded from abuse. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported in an environment that is homely and comfortable. Evidence: A good standard of cleanliness was evident throughout the home that was also bright and airy. The toilet and bathing facilities are suitable to meet the individual needs of the residents. A programme of repair and replacement is in place, and this is incorporated in the maintenance plan. The acting manager and support staff are responsible for maintaining health and safety checks and standards. A good standard of cleanliness was evident throughout those areas viewed. Food items were appropriately stored in fridges and temperatures, recorded daily. The home has an infection control policy and procedures in place and staff encourage residents to follow good hygiene practice. Staff members spoken to are conversant with infection control procedures. However, we saw that towels were used in communal bathroom and other means of hand drying facilities should be provided in the bathroom so as to control the spread of infection. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: As stated in the AQAA, the registered provider will within the next twelve months redecorate the hall, stairs and landing with brighter colours as requested by the residents and will also provide new flooring in the bathroom. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service do benefit from the care and support they receive from a qualified staff team but staff should receive structured induction and formal supervision so that residents would feel protected by the homes recruitment policy and practices. Evidence: Information gained from duty roster and staff members provides evidence that the day and night staffing levels remain adequate to meet the needs of the residents. Staff members have the necessary skills and they receive appropriate training to meet the varying needs of the residents. Staff spoken with indicated that they have opportunities for relevant training and this gives them greater confidence to do their jobs. Staff were very knowledgeable about the needs of individuals whom they were supporting and caring for. Currently, there are 6 care staff, 5 of whom have completed the NVQ Level 2 and another the Level 4. Six staff files were examined and these were found to contain all the required documents including two written references and CRB checks were carried before an offer of employment was made. However, the records showed that staff did not receive structured induction programmes so that they are able to fulfill the aims of the Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: home and meet the changing needs of the residents. Staff spoken to confirmed that they did not receive one to one formal supervision on a regular basis. Last supervision was done in April 2004. Staff confirmed that they received support from the management team and that senior members of staff were approachable and available for advice as and when needed. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their health and welfare are protected by policies and procedures but may be at risk if the bath hot water temperature is not reduce to the safe required level. Evidence: Currently, the home does not have a registered manager. The implementation of a number of systems including assessment and admission process, care planning and review, consultation and communication, recruitment of staff ensures that the home operates in an manner that benefits people using the service and the staff team. The home has a quality assurance system in place and seek the views of people using the service, relatives, staff and other interested parties. However, the records showed that staff had not received training in infection control. This training should be provided so that safe practices are maintained to control the spread of infection. All statutory records were available for inspection and maintained in accordance with Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of people using the service and staff are promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. A valid Employers Liability insurance certificate was displayed and expires on the 30th April 2010. As stated in the AQAA, the provider will ensure that a registered manager will be in post for the care home within the next twelve months. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be in a format that is user friendly and easy to read. The Service Users Guide should include the complaints procedure. The complaints procedure should include timescales for responding to complaints and should be updated to provide the correct contact details of the Commission. An audit of residents money handed over for safe keeping should be carried out on a regular basis so that residents are protected and safeguarded from abuse. Other means of hand drying facilities rather than the towels should be provided so as to control the spread of infection. All staff should receive structured induction training so that they are able to fulfill the aims of the home and meet the changing needs of the residents. All staff should have regular, recorded supervision meetings at last six times a year. Training in hygiene and control of infection should be provided for all staff so that safe practices are maintained to control the spread of infection. Page 25 of 26 2 23 3 23 4 5 30 35 6 7 36 43 Care Homes for Adults (18-65 years) Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!